Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Sunday, July 06, 2008

Patient 1: 48 year old male with lung cancer and hemoptysis. In ER for 'worsening shortness of breath'. Decided to stop chemotherapy and XRT but not smoking. Smokes 'only a half a pack a day doc'.

Patient 2: 34 year old female with 4 months of pain from her scleroderma and out of all medicines. "They dropped me from my insurance because I missed so many appointments." Here today for worsening pain and because "they" won't see her in clinic anymore. Was able to provide me with list of twenty medicines she needs to have filled. Has no money. Smokes. Chief complaint? Pain from her fibromyalgia. "I have a port and I can help the nurse access it... really all I need is pain medicine". And oh by the way, she has become blind in her right eye over the past few weeks, but this really doesn't bother her as much as the pain.

18 comments:

Those patients left your ED and came to mine today. Gave them each one free time machine ticket, so they could go back in time and make completely different choices, including not to burden me with social problems.

As ER docs we are just lifeguards guarding the shallow end of the gene pool.

By golly, that's freaking brilliant. I'd toss you a lifeline, but I need one myself.

What really shoves the bamboo under my nails is that I bust my ass to make good choices regarding my health, yet I'm supposed to feel all gushy about the government stealing a growing percentage of my hard-earned royalty money to those who make crap decisions and have no money.

Do you suppose if people knew that no one was going to bail them out that they'd make better choices? Yeah, okay, maybe not. But at least I'd feel better about not being the government's blank check.

Frank, I wouldn't either. What's the point? And, if it's been diagnosed as "terminal," then what's the fuckin' point in running up huge XRT and chemo bills to boot? Palliative? That's what the cigs are for, and they're cheaper.

Wow, are you guys in my head? My father died of primary lung CA or maybe it was the metastatic? primary? brain CA. (More of a frontal/orbital cranial tumor than brain so technically, bone CA?) Not sure, just know he wouldn't quit smoking either. He lied to the docs and told them half a pack a day. I told them the truth, two to three packs a day.I got all indignant with him and wouldn't take him out to smoke when he was hospitalized the second time because I was lining the up the best neurosurgeon I knew to remove his tumor and dammit! I wasn't about to contribute to his demise while others were willing to help try and save him. Of course, none of it mattered and consciously, I knew it wouldn't. Besides, they all quit smoking eventually. My Step Dad had scleroderma, DMSO topically, IV and PO gave him many many extra years. His pain meds? Daypro. Maybe some vodka. Single worst thing you can do with scleroderma? Smoke. He did. Even set the O2 tubing, and his chair, and some of the carpet on fire once. He never quit either but to his credit he tried several times. Think his record was about three days. When the scleroderma finally went systemic, it got him.

Just like MMT, the docs I work with joke around with the irony that "everybody stops smoking eventually." This post just goes to show that a lot of times it isn't so funny. What a crappy way to die.Lynn - BINGO! A nation of enablers. Our ED just got a bunch of new beds so that we can now accommodate patients up to 700 pounds on each bed. The morbidly obese can now rest easy as they eat their next McBypass Burger knowing that they won't have to lay on the floor while we do CPR on them one day.

Well what's the good way? Maybe dying on the operating table while under anesthesia, but the legal profession is working hard at eliminating that. Or a very, very quick heart attack, but the medical profession is working hard to eliminate THAT.

My mom never smoked, was not overweight, did not have any chronic illnesses, ate all the right stuff, and she died a long, drawn out death, full of agonal breathing and other discomforts. Because her heart, which she had kept so healthy for so long, just wouldn't stop beating.

When it comes to dying, there aren't a whole lot of good ways to go. Maybe OD is not so bad, if you do it right. Maybe the drug seekers have a better plan than I do? I dunno.

i just finished your book, donovan's paradigm, and if you don't make the right thing happen in the sequel i'm gonna get ya! drop me an email and i'll elaborate but i don't want to spoil it for anyone! really enjoyed it... you managed a tricky balance very well and i read it cover to cover.

i just finished your book, donovan's paradigm, and if you don't make the right thing happen in the sequel i'm gonna get ya! (laughing) Yeah, I get that a lot. Tension is good for the soul, don't you think?

Thank you so much for your kind comments. Docs were never a part of my intended demographics but funnily enough, they're my primary readership - despite the subject matter. You guys are great.